Impact of the duration of normothermic regional perfusion on the results of liver transplant from controlled circulatory death donors: A retrospective, multicentric study

Abstract

In France, the program of controlled donation after circulatory death (cDCD) was established with routine use of in situ normothermic regional perfusion (NRP). There is currently no consensus on its optimal duration. The purpose was to assess the impact of NRP duration on liver graft function and biliary outcomes. One-hundred and fifty-six liver recipients from NRP-cDCD donors from six French centers between 2015 and 2019 were included. Primary endpoint was graft function assessed by early allograft dysfunction (EAD, according to Olthoff's criteria) and MEAF (model for early allograft function) score. Overall, three (1.9%) patients had primary non-function, 30 (19.2%) patients experienced EAD, and MEAF score was 7.3 (±1.7). Mean NRP duration was 179 (±43) min. There was no impact of NRP duration on EAD (170±44 min in patients with EAD vs. 181±42 min in patients without, P = .286). There was no significant association between NRP duration and MEAF score (P = .347). NRP duration did neither impact on overall biliary complications nor on non-anastomotic biliary strictures

Normothermic regional perfusion for donation after circulatory death donors

“…More recent studies have shown similar results [17 ▪▪ ,18 ▪ ]. There is also data to suggest that duration of NRP seemingly had no impact on the rates of early allograft dysfunction or biliary complications [19 ▪ ]. These data led one group to assert that DCD livers should no longer be considered ‘marginal donors’ when recovered with NRP [20].…”

Normothermic regional perfusion in liver transplantation from donation after cardiocirculatory death: Technical, biochemical, and regulatory aspects and review of literature

“…In published protocols, 44,45,47–52 they are measured immediately before starting NRP, after 1 h, and at the end of reconditioning. More frequent measurements are also reported 19–53 . Barcelona's team 44,45 adopted a threshold based on a maximum of three times the upper limit of normality at baseline and of four times at the end of NRP.…”

“…In general, expert consensus supports maintaining NRP 1–4 h 44,45 . No relationship between NRP duration and complication or graft loss was reported in specific studies 46,47 …”

“…In general, expert consensus supports maintaining NRP 1-4 h. 44,45 No relationship between NRP duration and complication or graft loss was reported in specific studies. 46,47 In general, blood samples are taken at baseline and periodically thereafter during NRP for biochemical evaluation (e.g. : pH, lactate, transaminases, injury, and regeneration markers).…”

Machine Perfusion for Extended Criteria Donor Livers: What Challenges Remain?

“…The leading countries using this technique routinely for DCD liver procurement are Spain, France, Italy and the United Kingdom (UK) [ 41 , 118 , 119 ]. During NRP, the abdominal organs release the well-known proinflammatory molecules of IRI, and some are used to assess and predict the liver performance after later implantation [ 112 , 117 ].…”